Healthcare Provider Details

I. General information

NPI: 1669669065
Provider Name (Legal Business Name): TONYA HAWKES DUKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MEDICAL DR PAIN AND SEDATION
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

PO BOX 30180 PAIN AND SEDATION
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-3595
  • Fax:
Mailing address:
  • Phone: 801-755-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5376205-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: